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Nucamendi-Guillén, Samuel
Systematic Review of Literature on Lean and Six Sigma in Healthcare and Directions for Future Research
2020
,
Nucamendi-Guillén, Samuel
,
Rodrigo E. Peimbert-garcía
,
Timothy Matis
,
Jonathan Cuevas-ortuño
Healthcare organizations have increasingly turned to Lean and Six Sigma (LSS) as management systems to
achieve quality and efficiency in patient care. This study aims to classify this body of literature and to
discover factors that enable and prevent successful LSS implementations. Peer-reviewed literature in
journals that were published through 2018 in English language were sought through a search of multiple
databases. The inclusion criterion was broad in that all areas of healthcare and interpretations of LSS were
considered. The literature search yielded 368 publications. One third of the studies present a U.S. affiliation
and only 19% has been conducted in developing countries. The case study is the most popular study type
but only represents around 52% of the body of literature. Lean and the ED are preferred approach and
setting, respectively. Factors that enable and prevent successful implementation were grouped by
Managerial, Preparation, People, and Project relationships. There is a need for future literature to provide a
longitudinal balanced view on the benefits and challenges of implementations, and for studies to follow
experimental designs for statistical validity. This is the most inclusive review about LSS in healthcare as it
includes different study types, healthcare settings and LSS tools together.